National Center for Emerging and Zoonotic Infectious Diseases

Division of Global Migration and Quarantine

Alfonso Rodriguez-Lainz, PhD, DVM, MPVM Division of Global Migration and Quarantine

U.S-Mexico Unit Summer Institute in Migration and Global Health

June 22, 2015

U.S Government Efforts Addressing Migrant Health

Overview

Who is a migrant?

U.S federal agencies with a migrant health role Focus on the CDC

Opportunit ies

Who is a migrant (in the U.S)?

• Migrants (~Foreign-born): Individuals born outside the U.S. or U.S territories* and currently residing in the U.S. • ~41 million migrants in the U.S (2013)

*Puerto Rico, U.S Island territories (e.g., Guam)

• No international (or U.S) standard definition

Migrants include: • Different legal migration status:

• Naturalized citizens, green card, temporary work visa • Unauthorized, refugees, victims of trafficking

• (Many) Different occupations

U.S federal agencies with a migrant health role

Department of State

• Office to Monitor & Combat Trafficking in Persons ww.state.gov/j/tip/

• U.S Trafficking Victims Protection Act of 2000

Department of Homeland Security

• Immigration and Customs Enforcement Health Service Corps – Coordinates health services in immigration

detention centers

Depart. of Health and Human Services

• HRSA-Migrant Health Program – Funding to community clinics

providing services to migrant farmworkers

• Office of Refugee Resett lement

– Local integration of refugees – Unaccompanied children services

• Centers for Disease Control and

Prevent ion (CDC)

CDC programs and act ivit ies on migrant health

CDC Division of Global Migrat ion and Quarant ine (DGMQ)

Prevent the introduct ion and spread of communicable diseases through regulation, science, preparedness and response

Reduce morbidity and mortality among immigrants, refugees, t ravelers and other globally mobile populat ions

DGMQ’s Regulatory role

Full medical examination (including TB tests) and required vaccinations for green card applicants and refugees

~1 million/year 50% overseas and 50% in the U.S

Modernized regulat ions, policy, and guidance

DGMQ’s Response to Global Emergencies

CDC Public Health Emergency Response

• Gaps: CDC emergency plans have limited information on how to communicate with migrants in the U.S during emergencies

• Developed communicat ion plan for

outreach to non-English speakers – Defining critical documents for translation – Directory of Spanish-speaking migrant-serving

organizations and ethnic media (with HIA)

Ebola and the West African Diaspora in the U.S

• Developed targeted communication

materials

• Regular community conference calls

• Addressed stigmatization

Continuity of care for TB cases crossing the U.S-Mexico border

• CureTB and TB Net programs

• Partners: CDC, U.S and Mexico TB programs, USMBHC, ICE

• TB care is readily available throughout U.S (including migrants)

• Current focus: deportation of migrants with TB

Health communicat ion

• Plain language educational materials in multiple languages

• Collaboration with Binational

Health Week (HIA)

CDC Office of Minority Health and Health Equity

• CDC Migrant Health Working Group

• Federal Language Access Init iat ive – Assess and address gaps in access to CDC services

for individuals with limited English proficiency

Migrant health disparit ies

• (1st) CDC Conference on Migrant Health Disparit ies (May, 2014)

• CDC Health Disparit ies Reports (2011, 2013) • Reporting of foreign-born data and health issues

• Analysis of nat ional health information data

by region of birth – E.g., National Immunization Survey

Coverage Levels for 4:3:1:3*:3:1:4 Vaccinat ion Series Complet ion in Children (19–35 Months),

by Race/Ethnicity (2010–2012)

Coverage Levels for 4:3:1:3*:3:1:4 Vaccinat ion Series Complet ion in Children (19–35 Months), by Nativity and by Race/Ethnicity (2010–2012)

National health data sources

• Enhanced collect ion of migrat ion-related data (e.g., country of birth, time in the U.S) – National Notifiable Diseases Surveillance System

• Country of birth (added in 2014)

- Recommendations on HIV Surveillance for Latino migrants

Migrant health targeted surveys

• Immunization coverage surveys – Mexicans (Los Angeles County) – Indigenous Mexicans (San Diego) – School-based survey of Somali children (CA)

• Mental health survey of Iraqis (Ohio, California and Texas)

Migrant health: opportunit ies

Opportunit ies

1. Enhance access to health care and preventive services Affordable Care Act

Opportunit ies

2. Enhance migrant health monitoring Collection and reporting of country of birth,

language and other migration-related variables (e.g., years in the U.S)

Include migrants in national health information systems

Opportunit ies

3. Increase awareness and address migrant health disparities Emphasize both health disparities AND health

advantages of migrants Recognize migration as a Social Determinant

of Health

Opportunit ies (Cont.)

4. Public health intervent ions target ing migrant populat ions with highest risk and/or burden of disease E.g., hepatitis B among Vietnamese-born

Opportunit ies (Cont.)

5. Access to language services Translators and interpreters Multilingual communication and education

materials Collaboration with ethnic media Multilingual data collection instruments

Biomosaic: a CDC Web-based interactive GIS application for migration and health

Salvadorians living in the U.S by county

Opportunit ies (Cont.)

6. Coordination between U.S agencies and organizations serving migrants

https://www.whitehouse.gov/issues/immigration/new-americans

https://www.whitehouse.gov/sites/default/files/docs/final_tf_newamericans_report_4-14-15_clean.pdf

Opportunit ies (Cont.)

7. Collaboration between U.S and … Agencies and organizations in countries of

origin (e.g., Mexico’s Migrant Health Program) International agencies working on migrant

health (e.g, IOM, European Union)

Opportunit ies (Cont.)

8. Include migrant health in global health initiatives In countries of origin, transit and destination

Migrants: a shared populat ion,

a shared responsibility

For more information, please contact: Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636) / TTY: 1-888-232-6348 E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for Emerging and Zoonotic Infectious Diseases

Division of Global Migration and Quarantine

Thank you! ¡Muchas gracias!

U.S Government Efforts Addressing Migrant Health OverviewWho is a migrant (in the U.S)?Migrants include:U.S federal agencies with a migrant health role�Department of StateDepartment of Homeland SecurityDepart. of Health and Human ServicesCDC programs and activities on migrant health�CDC Division of Global Migration and Quarantine (DGMQ)��DGMQ’s Regulatory roleSlide Number 12CDC Public Health �Emergency ResponseEbola and the West African Diaspora in the U.S�Continuity of care for TB cases crossing the U.S-Mexico borderHealth communicationCDC Office of Minority Health �and Health Equity�Migrant health disparitiesCoverage Levels for 4:3:1:3*:3:1:4 Vaccination Series Completion in Children (19–35 Months), by Race/Ethnicity (2010–2012)�Coverage Levels for 4:3:1:3*:3:1:4 Vaccination Series Completion in Children (19–35 Months), by Nativity and by Race/Ethnicity (2010–2012)�National health data sourcesMigrant health targeted surveysMigrant health: opportunities�OpportunitiesOpportunitiesOpportunitiesOpportunities (Cont.) Opportunities (Cont.)Biomosaic: a CDC Web-based interactive GIS application for migration and healthOpportunities (Cont.)Opportunities (Cont.)Opportunities (Cont.)Migrants: a shared population, ��a shared responsibilitySlide Number 34